Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
MCH Jurisdictional Survey Instrument for the Title V MCH Block Grant Program Modified 14500 3155 0 Form and Instruction 1a MCH-JS Survey_2024_American Samoa_English.docx
Form and Instruction 1b MCH-JS Survey_2024_American Samoa_Samoan
Form and Instruction 2a MCH-JS Survey_2024_CNMI_English
Form and Instruction 3a MCH-JS Survey_2024_FSM_Chuukese
Form and Instruction 3b MCH-JS Survey_2024_FSM_English
Form and Instruction 3c MCH-JS Survey_2024_FSM_Pohnpeian
Form and Instruction 4a MCH-JS Survey_2024_Guam_English
Form and Instruction 4b MCH-JS Survey_2024_Guam_Tagalog
Form and Instruction 5a MCH-JS Survey_2024_Palau_English
Form and Instruction 5b MCH-JS Survey_2024_Palau_Palaun
Form and Instruction 5c MCH-JS Survey_2024_Palau_Tagalog
Form and Instruction 6a MCH-JS Survey_2024_Puerto Rico_English
Form and Instruction 6b MCH-JS Survey_2024_Puerto Rico_Spanish
Form and Instruction 7a MCH-JS Survey_2024_RMI_English
Form and Instruction 7b MCH-JS Survey_2024_RMI_Marshallese
Form and Instruction 8a MCH-JS Survey_2024_USVI_English
Form and Instruction 8b MCH-JS Survey_2024_USVI_Spanish
Form and Instruction 4c MCH-JS Survey_2024_Guam_Chuukese
Total burden requested under this ICR: 14500 3155 0  
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